Newsom Score for Non-traumatic Chest Pain

Newsom Calculator

Age

Sex

Pain Character

Reproducible with Palpation

Associated Symptoms (diaphoresis, dyspnea, radiation to arm/jaw, nausea)

ECG Findings

Newsom Score: –

–

Rules out need for chest x-ray in chest pain patients (non-traumatic).

Why Use

Can potentially safely eliminate unnecessary x-ray in patients presenting to EDs with non-traumatic chest pain (92.9% sensitive, NPV 98.4% for clinically relevant ED findings on chest x-ray). In the validation study, application of the score would have decreased chest x-ray usage by 28.9%. The study authors estimate a potential decrease of $58 million per year in healthcare costs as a result of the potential decrease number of chest x-rays performed with application of the clinical decision tool.

When to Use

Patients presenting to the emergency department for non-traumatic chest pain.

Formula

Selection of the appropriate criteria: Criteria Age ≥60 years CHF history Smoking history Hemoptysis Tuberculosis history Thromboembolic history Prior/current alcohol abuse Fever ≥100.4°F (38°C) Oxygen saturation <90% Respiratory rate >24 Diminished breath sounds Rales

Pearls / Pitfalls

Application of this decision tool would have missed five clinically relevant diagnoses in the study population: three pneumonias and two pleural effusions. The prevalence of clinically relevant ED findings on chest x-ray in the study population was 6.4%. In populations where prevalence is higher, negative predictive value (98.4% in the study) would decrease ( Newsom 2018 ).

Critical Actions

Consider prevalence of clinically significant chest x-ray findings in your population in comparison to the study population before applying the clinical decision tool to your practice. Though the criteria had excellent sensitivity and NPV for the study population, it did miss cases of pneumonia and pleural effusions. If clinical suspicion for these diagnosis is high despite absence of study criteria, consider performing chest x-ray.

More Information

Interpretation: Criteria present Risk group Recommendation 0 Low Chest x-ray not needed >0 Not low Consider chest x-ray